Legislature Set to Advance Contentious Nursing Home Staff-Ratio Bill

Frontline workers call for more help, but industry fears an “unfunded mandate”

When Sherry McGhie started in nursing-home care nearly 30 years ago, she was responsible for roughly half the number of residents she is today, and far fewer faced mobility challenges or mental illness. Staff had time to provide proper care and companionship to all the seniors under their watch, she recalled.

Today, it’s a struggle for certified nursing aides like her to get all their patients up and dressed every day, McGhie said, let alone socializing with them or filling out all the necessary paperwork. “It’s unacceptable. We can’t do this to people,” the Passaic resident noted. “What happened to the care and compassion we say we have for the elderly?”

New Jersey lawmakers are scheduled to consider a bill later this week that could ease some of the burden on CNAs like McGhie by establishing staff-to-patient ratios for these frontline workers, who assist nursing home residents with 90 percent of their care, including dressing, bathing, and eating. Supporters believe the measure would result in better care for residents and improved working conditions for caregivers.

The legislation was first scheduled for a vote in the Senate Monday, but it was pulled as industry pushed for amendments; Senate leaders are expected to post the original version for Thursday’s voting session. The full Assembly has yet to take up the matter, and most likely will not do so until after the summer break.

Unfunded mandate feared

Industry leaders, however, fear the legislation amounts to an unfunded mandate — a statutory requirement to hire thousands of additional workers in a field already stressed by a labor shortage, at a total cost of $95 million annually. Nursing homes in New Jersey are already losing more than $400 million providing care for Medicaid patients, given the high costs involved and limited state funding. (Lawmakers are also looking at a bill to boost per-diem reimbursements for nursing home care.)

“Both the process and the policy couldn’t be worse,” said Jonathan Dolan, president and CEO of the Health Care Association of New Jersey, a nonprofit that represents more than half the nursing homes in the state. Without a proper labor pool to recruit from, he said the bill is only setting facilities up for failure — particularly those who care for low-income Medicaid patients. “It will only hurt those who need help the most,” Dolan said.

More than 600 Garden State facilities are licensed to provide long-term care for seniors and other residents, including 28,000 covered by Medicaid. The average age of residents is 85 years; according to one study, seven out of 10 Americans will need nursing home care at some point in their lives. In New Jersey, long-term residential care can cost as much as $100,000 a year.

Taking the measure of the measure

The bill to boost CNA staffing (S-1612), championed by Sen. Brian Stack (D-Hudson), dates back to 2015; the measure passed the Legislature that year but was pocket vetoed by former Gov. Chris Christie, a Republican. Leaders of 1199SEIU, a labor union that represents 8,000 nursing home workers in New Jersey, believe they have a better chance this year with Gov. Phil Murphy, a Democrat, who has expressed support for a variety of patient-safety and labor-friendly initiatives.

Bryn Lloyd-Bollard, communications director for 1199SEIU, said seven other states have adopted staffing ratio-bills related to CNAs, including Delaware and Maine. New Jersey now ranks near the bottom nationwide for the number of nursing hours staff can provide to each patient, he said.

While the current law dictates how many hours of care must be provided, Stack’s bill would establish clear staff-to-patient ratios that are easier for residents and family members to understand, Lloyd-Bollard said. The legislation calls for one CNA per eight residents in the morning, one for 10 in the evening, and one for 16 overnight.

Mandating this level of staffing will also help stabilize the CNN workforce, Lloyd-Bollard noted, which has extremely high turnover rates: Some facilities lose 75 percent to 100 percent of their workforce each year. “There’s a constant revolving door with CNAs,” he said, noting that these workers generally earn between $11 and $13 an hour.

Industry representatives also praised the daily work of these CNAs, but fear a staff-ratio bill will not give facilities the flexibility they need to operate professionally. Dolan said this policy devalues the work nurses do by casting them as a number alone, a position shared by Aline Holmes, a nurse and senior vice president of clinical affairs for the New Jersey Hospital Association, who outlined her concerns about the hospital staff-ratio bill earlier this month in an op-ed for NJ Spotlight.

An incomplete picture?

Dolan said the legislation has several flaws, including the fact that the ratio does not account for the presence of other nursing professionals, who play critical roles in daily patient care; legislation in other states has factored in the presence of RNs and LPNs, or licensed practical nurses. In addition, he indicated the bill fails to include any funding to pay for the extra workers it would take to meet the mandate.

Efforts to amend the bill have essentially stalled, Dolan said, and nursing home operators plan to press their case in the Assembly and with Murphy. The measure was already tweaked to exclude pediatric long-term care wards, which generally involve more highly specialized clinical care.

In addition, changes could be made through the existing state regulations, Dolan said, without the need for legislation. That thought was seconded by Chrissy Buteas, chief government affairs officer with the New Jersey Business & Industry Association, which has also raised concerns about the proposal.

"NJBIA places a strong and consistent focus on the quality and affordability of healthcare in our state, and there are ways to attract and retain a qualified workforce of CNAs that do not require artificial, restrictive staffing ratios," said Buteas, who previously led the Home Care & Hospice Association of New Jersey, which advocates for programs and services that allow elderly and disabled residents to remain independent at home.